CAPE ELIZABETH — During recent debates over health care reform, opponents of “Medicare for All” (“single-payer”) have often argued that physicians would suffer because, to pay for it, their reimbursement would have to be reduced. The Partnership for America’s Health Care Future – a consortium of pharmaceutical companies, hospital chains, insurance companies and others bent on maintaining our present multipayer system – sounded this alarm last May: If payment rates were reduced, the industry coalition warned, fewer people might enter the profession, and the amount and quality of care would probably decrease.
Not included in this prediction, though, was any acknowledgment of the savings physicians would enjoy in a Medicare for All system: reduction in billing and insurance expenses (now $20 for a primary care visit, more for more-complex encounters); elimination of commercial health insurance for themselves and staff; reduction in malpractice insurance (half of malpractice awards go to cover health care costs, which would no longer be included), and workers’ compensation insurance. These savings would significantly blunt any reduction in reimbursement.
Also not included in the coalition’s forecast of physician dissatisfaction with the Medicare for All model was any mention of the ongoing evolution in the medical profession’s attitude toward publicly funded, privately provided health care. When President Truman tried to get a national health insurance plan passed in the 1940s, the then-powerful American Medical Association successfully lobbied against the bill as “socialized medicine,” and reluctantly accepted Medicare in the ’60s because it applied only to the then-very limited demographic of the elderly. (Americans’ life span in 1960 was 70 years, compared to 79 years today.) Indicative of many physicians’ attitude toward government involvement in health care funding in that era were the AMA’s 1957 Principles of Medical Ethics, which stated that “a physician may choose whom he will serve.” No mention there of broader social responsibility for physicians, but the 2001 revision of the Principles added this: “A physician shall support access to medical care for all people.”
In 1987, Physicians for a National Health Program was founded, and now has over 20,000 members who educate about and advocate for Medicare for All and related universal health care plans, including their own proposal. A 2008 Merritt-Hawkins physician survey found that 42 percent of physicians strongly or somewhat supported the “single-payer” model of health care, but their repeat study in 2017 found that 56 percent did. Last August, the AMA, which had joined the Partnership for America’s Health Care Future early on, withdrew its support of the industry coalition and, presumably, its arguments and goals.
And, very significantly, just two weeks ago the American College of Physicians – the professional organization of internists and second-largest physician organization in the country after the AMA – announced in the Annals of Internal Medicine its support of either a single-payer system or a public option: “The evidence suggests that publicly financed and administered plans have the potential to reduce administrative spending and associated burdens on patients and clinicians (my italics) compared with private insurers.” (In an accompanying commentary, health policy experts and Physicians for a National Health Plan founders Steffie Woolhandler, M.D., MPH, and David Himmelstein, M.D., argue against the public option and in favor of single-payer.)
No doubt, a number of physicians do share some of the concerns that the Partnership for America’s Health Care Future has about major health care reform. As voters weigh the arguments for and against Medicare for All, however, they should know that increasingly, the medical profession supports such an approach. They might even consider asking their own doctor what he or she thinks about it.
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